Access to Insurance and Length of Psychiatric Stay Among Adolescents and Young Adults Discharged from General Hospitals

Abstract

Home and community based care services constitute a public initiative in the development of a long term care service network. One such home based initiative is the personal care service program of Medicaid. The authors conducted a national survey of administrators of this program. They received a response from 16 administrators of such programs in 1987-1988. The responses raise significant issues regarding training, access to and equity of services, quality of services, administrative oversight and the coordination of home-based care in a network of available services. Based on administrator responses, the authors draw several conclusions.

Patterns of adolescent psychiatric hospitalization: Implications for social policy.

“…As the findings indicate, diagnosis alone is not an adequate indicator of appropriate hospitalization, since this designation is probably influenced by insurance criteria (Butts & Schwartz, in press; Kirk & Kutchins, 1988). In California, the primary diagnosis of the majority of both private and publicly supported youths was affective disorder.…”

“…Butts and Schwartz (in press) argued that no studies clearly show that inpatient treatment is more effective in treating adolescents' mental illness and that therefore length of stay, in itself, is a measure of inappropriateness. By this criterion, privately insured minor patients in California, since they stay an average of eight days longer than do Medi-Cal patients, are more inappropriately held than are publicly funded patients.…”

“…However, these data, which are based on sample surveys conducted by the Survey and Reports Branch, provide inadequate samples for some of the information on the hospitalization of minority youths. Other published reports on the characteristics of hospitalized youths deal with specific limited data bases, such as that provided by the Committee on Professional and Hospital Activities (CPHA), which includes nonfederal, short-term general hospitals (Butts & Schwartz, in press; Jackson-Beeck et al, 1987). Although these sources are valuable, they are not comprehensive.…”

Community‐Based Interventions: A Return to Community Mental Health Centers' Origins

“…Community-based treatments have repeatedly been shown to offer a higher level of positive outcomes, without the potential physical and psychological risks associated with inpatient services (Weithorn, 1988). Schwartz (1989b) noted that there are no studies that demonstrate the superiority of residential or inpatient programs over other treatment options (see also Butts & Schwartz, 1991). Such research findings have caused many authors to argue strongly for a decrease in inpatient services (Dougherty, 1988;Saxe et al, 1988).…”